Effects of dietary recommendations for reducing free sugar intakes, on free sugar intakes, dietary profiles and anthropometry: a randomised controlled trial

Free sugar intakes are currently higher than recommended for health, yet effective strategies for reducing consumption are yet to be elucidated. This work investigated the effects of different dietary recommendations for reducing free sugar (FS) intakes, on relevant outcomes, in UK adults consuming > 5 % of total energy intake (TEI) from FS. Using a randomised controlled parallel-group design, 242 adults received nutrient-based (<i>n</i> 61), nutrient- and food-based (<i>n</i> 60), nutrient-, food- and food-substitution-based (<i>n</i> 63) or no (<i>n</i> 58) recommendations for reducing FS at a single timepoint, with effects assessed for the following 12 weeks. Primary outcomes were FS intakes as a percentage of TEI (%FS) and adherence to the recommendations at week 12. Secondary outcomes included TEI, diet composition, sugar-rich and low-calorie-sweetened food consumption and anthropometry. In intention-to-treat analyses adjusted for baseline measures, %FS reduced in intervention groups (%FS_change = -2·5 to -3·3 %) compared with control (%FS_change = -1·2 %) (smallest B = -0·573, <i>P</i> = 0·03), with effects from week 1 until week 12 and no differences between interventions (largest B = 0·352, <i>P</i> = 0·42). No effects of the interventions were found in dietary profiles, but change in %FS was associated with change in %TEI from non-sugar carbohydrate (B = 0·141, <i>P</i> < 0·01) and from protein (B = -0·171, <i>P</i> = 0·02). Body weight was also lower at week 12 in intervention groups compared with control (B = -0·377, <i>P</i> < 0·05), but associations with %FS were weak. Our findings demonstrate the benefit of dietary recommendations for reducing FS intakes in UK adults. Limited advantages were found for the different dietary recommendations, but variety may offer individual choice.